Case report of subacute presentation of tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli: a multifactorial aetiology

Myslivecek, Libor, Gue, Ying ORCID: 0000-0001-9994-8915 and Vasiliadis, Ioannis (2021) Case report of subacute presentation of tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli: a multifactorial aetiology. EUROPEAN HEART JOURNAL-CASE REPORTS, 5 (8). ytab282-.

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Official URL: http://dx.doi.org/10.1093/ehjcr/ytab282

Abstract

<h4>Background</h4>Right heart thrombus (RHTh) complicated by pulmonary embolism (PE) usually presents as a medical emergency with significant haemodynamic instability. However, less is known about subacute presentations.<h4>Case summary</h4>We present a 74-year-old haemodynamically stable gentleman with a 3-week history of mild pleuritic chest pain and exertional dyspnoea preceded by lower respiratory tract infection. Early trans-thoracic echocardiogram (TTE) revealed a 3 cm elongated tricuspid valve thrombus with right ventricular dysfunction, new-onset atrial fibrillation, and new-onset severe left ventricular impairment. Subsequent computed tomography pulmonary angiogram showed widespread bilateral pulmonary emboli with retrograde opacification of the hepatic veins. The RHTh successfully resolved with warfarin therapy with no further complications, and the patient was discharged on Day 8 of hospitalization.<h4>Discussion</h4>An early TTE is crucial in detecting the RHTh in patients suspected of PE and can significantly change the management compared with uncomplicated PE. The index of suspicion for PE and RHTh should remain high even in subacute cases.

Item Type:	Article
Uncontrolled Keywords:	Right heart thrombus, Tricuspid valve thrombus, Pulmonary embolism, Trans-thoracic echocardiogram, Case report
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	09 Dec 2021 12:40
Last Modified:	06 Sep 2023 10:05
DOI:	10.1093/ehjcr/ytab282
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3145079